血清胱抑素C对慢加急性肝衰竭患者肾损伤的早期诊断意义

Significance of serum cystatin C level for early diagnosis of acute kidney injury in patients with acute-on-chronic liver failure

目的研究血清胱抑素C(CysC)水平对慢加急性肝衰竭(ACLF)患者急性肾损伤(AKI)的早期诊断意义。方法选取2011年8月-2012年10月于本院住院的慢性乙型肝炎相关慢加急性肝衰竭(ACLF)、慢性乙型肝炎(CHB)的患者各60例,同期60例健康者作为对照。肝衰竭患者随访至出院,动态收集患者血清。采用胶乳增强免疫比浊法测定血清CysC水平。通过绘制CysC、肌酐和血钠浓度诊断AKI的受试者工作特征曲线(ROC),获得其曲线下面积(AUC)及最佳临界值。正态分布的计量资料,多组间比较采用单因素方差分析(One-way ANOVA),2组间比较采用双侧t检验;否则,组间比较采用Mann-Whitney U检验。计数资料采用χ2检验。相关分析采用Pearson相关检验。AUC及最佳临界值的计算采用Medcal 12.7.1.0进行分析。结果肝衰竭患者血清CysC水平为(1050±444)ng/ml,显著高于健康对照组(638±275)ng/ml(P=0.016)和CHB组患者(661±225)ng/ml(P=0.028)。ACLF患者血清CysC水平与肌酐水平相关性不显著(r=0.311,P>0.05),但与MELD评分呈显著正相关(r=0.529,P<0.01)。住院期间,共有8名肝衰竭患者(13.3%)发展为急性肾损伤,多元Logistic回归分析结果显示,血清CysC水平是ACLF患者发生肾损伤的独立影响因素(OR=1.008,P=0.021)。AUC分析显示早期诊断ACLF患者急性肾损伤的血清CysC水平建议值为1210 ng/ml。结论血清CysC检测有助于ACLF伴肌酐水平正常患者住院期间发生急性肾损伤的早期预测。

Objective To investigate the significance of serum cystatin C （CysC） level for the early diagnosis of acute kidney injury （AKI） in patients with acute-on-chronic liver failure （ACLF）. Methods Sixty patients with chronic hepatitis B - related ACLF and 60 patients with CHB, as well as 60 healthy controls, were included in the study. The ACLF patients were followed up until discharge, and serum samples were collected during hospital stay. Serum CysC level was measured by latex - enhanced immunoturbidimetric assay. The receiver operating characteristic （ROC） curves of serum CysC, ereatinine （Cr） , and sodium levels for the diagnosis of AKI were drawn, and the areas under the ROC curves （AUCs） and optimal cut-off values were determined. For normally distributed measurement data, comparison between groups was made by one way analysis of variance, and multiple comparisons were made by two-sided t test; otherwise, comparison between groups was made by Mann - Whitney U test. Enumeration data were analyzed by chi - square test. The Pearson correlation test was used for correlation analysis. The AUCs and optimal cut - off values were calculated by Medcal 12.7.1.0. Results The serum CysC level in ACLF patients was 1050±444 ng/ml, which was significantly higher than those in healthy controls （638±275 ng/ml, P =0. 016） and CHB patients （661±225 ng/ml, P = 0. 028 ） ; for ACLF patients, serum CysC level was not significantly correlated with serum Cr level （ r =0. 311, P 〉0.05 ） , but showed a significant positive correlation with MELD score （ r = 0. 529, P 〈 0. 01 ）. During hospital stay, 8 （ 13.3% ） of ACLF patients developed AKI. The multivariate logistic regression analysis indicated that serum CysC level was the independent risk factor for AKI development in ACLF patients （ OR = 1. 008, P =0.021 ）. The cut - off value of serum CysC level for the early diagnosis of AKI in ACLF patients was 1210 ng/ml. Conclusion Elevated serum CysC level may provide an early prediction of AKI development in ACLF patients with a normal serum Cr level during hospital stay.